Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department – NPO Guidelines

Anesthesia/Sedation Preoperative Care and Preparation Clinical Pathway, Inpatient and Emergency Department

NPO Guidelines

  • NPO Policy for Patients to Undergo General Anesthesia
    • Restrictions apply to all enteral routes
      • e.g., oral, NG, NJ, GT, G-J
    • Trauma patients with continuous J-tube feeds, conversation between Anesthesia and Trauma teams Frequent NPO Considerations
  • Oral medications may be given with a small amount of Jell-O or water ice. Avoid pudding or apple sauce.
  • Some medications may need to be held prior to general anesthesia/sedation due to unwanted side effects
  • Review scheduled medication guidance
  • Strict adherence to 8 hr NPO required if diseases that delay gastric emptying are present
    • e.g., diabetes, achalasia, severe gastroesophageal reflux

Enteral Intake Timing Before Procedures

Inpatient RN contacts procedural area for updated procedure time to guide NPO time.

Food Type Examples Age Minimum NPO Time
Prior to Procedure
  • Solids
    • Semi solid foods
    • Baby food
    • Applesauce
    • Pudding
  • Fortified breastmilk or formulas
    • Infant/pediatric formulas, > 20 kcal/oz
    • Thickeners, MCT oil, fiber
  • Protein shakes
 All 8 hrs
Unfortified formula, 20 kcal 6-12 mos 6 hrs
< 6 mos 4 hrs
Unfortified breastmilk All 3 hrs
  • Clear Liquids
    • Water
    • Pedialyte
    • Apple juice, no pulp
    • Clear white grape juice
    • Sports drinks, Gatorade or PowerAde
    • Small amount Jell-O or water ice for med administration
 All 1 hr